Archive | Health

Posted on 07 January 2019

A new data analysis by ProPublica and the Urban Institute shows more than half of older U.S. workers are pushed out of longtime jobs before they choose to retire, suffering financial damage that is often irreversible.

Tom Steckel hunched over a laptop in the overheated basement of the state Capitol building in Pierre, South Dakota, early last week, trying to figure out how a newly awarded benefit claims contract will make it easier for him do his job.

Steckel is South Dakota’s director of employee benefits. His department administers programs that help the state’s 13,500 public employees pay for health care and prepare for retirement.

It’s steady work and, for that, Steckel, 62, is grateful. After turning 50, he was laid off three times before landing his current position in 2014, weathering unemployment stints of up to eight months.

When he started, his $90,000-a-year salary was only 60 percent of what he made at his highest-paying job. Even with a subsequent raise, he’s nowhere close to matching his peak earnings.

Money is hardly the only trade-off Steckel has made to hang onto the South Dakota post.

He spends three weeks of every four away from his wife, Mary, and the couple’s three children, who live 700 miles away in Plymouth, Wisconsin, in a house the family was unable to sell for most of the last decade.

Steckel keeps photos of his wife, Mary, and their three children on the mantel at his rented place in Pierre. (Ackerman + Gruber, special to ProPublica)

With Christmas approaching, he set off late on Dec. 18 for the 11-hour drive home. When the holiday is over, he’ll drive back to Pierre.

“I’m glad to be employed,” he said, “but this isn’t what I would have planned for this point in my life.”

Many Americans assume that by the time they reach their 50s they’ll have steady work, time to save and the right to make their own decisions about when to retire.

But as Steckel’s situation suggests, that’s no longer the reality for many — indeed, most — people.

ProPublica and the Urban Institute, a Washington think tank, analyzed data from the Health and Retirement Study, or HRS, the premier source of quantitative information about aging in America. Since 1992, the study has followed a nationally representative sample of about 20,000 people from the time they turn 50 through the rest of their lives.

Through 2016, our analysis found that between the time older workers enter the study and when they leave paid employment, 56 percent are laid off at least once or leave jobs under such financially damaging circumstances that it’s likely they were pushed out rather than choosing to go voluntarily.

Only one in 10 of these workers ever again earns as much as they did before their employment setbacks, our analysis showed. Even years afterward, the household incomes of over half of those who experience such work disruptions remain substantially below those of workers who don’t.

“This isn’t how most people think they’re going to finish out their work lives,” said Richard Johnson, an Urban Institute economist and veteran scholar of the older labor force who worked on the analysis. “For the majority of older Americans, working after 50 is considerably riskier and more turbulent than we previously thought.”

The HRS is based on employee surveys, not employer records, so it can’t definitively identify what’s behind every setback, but it includes detailed information about the circumstances under which workers leave jobs and the consequences of these departures.

We focused on workers who enter their 50s with stable, full-time jobs and who’ve been with the same employer for at least five years — those who HRS data and other economic studies show are least likely to encounter employment problems. We considered only separations that result in at least six months of unemployment or at least a 50 percent drop in earnings from pre-separation levels.

Then, we sorted job departures into voluntary and involuntary and, among involuntary departures, distinguished between those likely driven by employers and those resulting from personal issues, such as poor health or family problems. (See the full analysis here.)

We found that 28 percent of stable, longtime employees sustain at least one damaging layoff by their employers between turning 50 and leaving work for retirement.

“We’ve known that some workers get a nudge from their employers to exit the work force and some get a great big kick,” said Gary Burtless, a prominent labor economist with the Brookings Institution in Washington. “What these results suggest is that a whole lot more are getting the great big kick.”

Posted on 25 October 2018

By Ruth Canovi

Congratulations to the Hartford City Council on passing an ordinance that raises the age of sale of tobacco products to 21. The ordinance, which was introduced by Councilman Larry Deutsch, makes Hartford the first city in the State of Connecticut to pass this policy.

The ordinance, which includes the purchase of electronic cigarettes, was passed just weeks after an announcement from the State Department of Public Health that the number of high school students using electronic cigarettes doubled in just two years.

According to their report, 14.7 percent of high school students reported current use of electronic nicotine delivery systems (ENDS), compared to 7.2 percent in 2015. The survey found one in 10 ninth graders and over one in five 12th graders currently use ENDS. That report mirror’s the American Lung Association’s State of Tobacco Control Report which concluded that 14 percent of high school students in the state of Connecticut are using tobacco.

We also know that nearly 95 percent of adult smokers report trying their first cigarette before the age of 21 – and that this policy can save lives.

In fact, according to the National Academy of Medicine (formerly the Institute of Medicine) increasing the minimum age of sale for all tobacco products to 21 could prevent 223,000 deaths among people born between 2000 and 2019, including 50,000 fewer dying from lung cancer – the nation’s leading cancer killer.

Some of those lives are Connecticut’s children — and we applaud Hartford for taking clear and decisive steps to safeguard their future.

The bottom line is that tobacco use remains the nation’s leading cause of preventable death and disease, and the leadership in Hartford should be an example for other local municipalities and the state. As of today, California, Hawaii, Maine, New Jersey, Oregon, and Massachusetts have led the way on tobacco 21, but with Hartford out in front, Connecticut should be next.

Posted on 16 October 2018

HARTFORD — Hartford City Council on Monday will vote on whether to raise the minimum age to purchase cigarettes.

Currently the minimum age to buy cigarettes and other tobacco is 18. The American Lung Association is pushing to change that age to 21.

The goal is the change the law first in Hartford and hope it spreads to other towns in the state.

After a rally at city hall on Monday, the nine-member council heard overwhelming support for the idea of raising the age for tobacco purchase in an effort to prevent nicotine addiction.

Advocates said that about 95 percent of smokers begin smoking before the age of 21 and become addicted as adults. By delaying the age when people begin using tobacco, it reduces the chance that they become lifelong tobacco users.

So far, six states and more than 350 cities have raised the age requirement to 21.

The Centers for Disease Control and Prevention estimates that 4,900 Connecticut residents will die from smoking-related causes this year. And more than 1,000 children are expected to become new daily smokers under the current law.

Earlier this year, advocates for raising the minimum age testified before a committee in the General Assembly, saying the annual health care costs directly caused by smoking are $2.03 billion and Medicaid costs are $520.8 million.

Raising the age to 21 has been proposed before the General Assembly several times but the measure has always failed.

Posted on 03 October 2018

HARTFORD — Displaced children and families of Hurricane Maria will now have access to mental health support services in Connecticut.

Thanks to a $750,000 federal grant released by the Department of Health and Human Services to help those who were evacuated from their homes in Puerto Rico in last September’s hurricane.

About 135,000 people evacuated Puerto Rico to the mainland in the first six months after the hurricane. And about 10 percent, or 13,500, relocated to Connecticut, according to the Center for Puerto Rican Studies at Hunter College.

The grant will be administered by the Department of Mental Health and Addiction Services and the Department of Children and Families in Hartford, New Haven, Bridgeport, Waterbury and New Britain. The services will include mobile crisis, outpatient counseling, medication management and school outreach.

“Many of the children and families who were evacuated to Connecticut after Hurricane Maria experienced severe trauma, enduring the powerful storm itself, the devastation of losing their homes and then having to acculturate to a new community,” DMHAS Commissioner Miriam Delphin-Rittmon said. “ We know that addressing trauma early leads to improved mental health outcomes, so providing this support is critical in ensuring families will thrive.”

Posted on 17 September 2018

In recent months, mothers who nearly died in the hours and days after giving birth have repeatedly told ProPublica and NPR that their doctors and nurses were often slow to recognize the warning signs that their bodies weren’t healing properly. Now, an eye-opening new study substantiates some of these concerns.

The nationwide survey of 372 postpartum nurses, published Tuesday in the MCN/American Journal of Maternal/Child Nursing, found that many of them were ill-informed about the dangers new mothers face. Needing more education themselves, they were unable to fulfill their critical role of educating moms about symptoms like painful swelling, headaches, heavy bleeding and breathing problems that could indicate potentially life-threatening complications.

By failing to alert new mothers to such risks, the peer-reviewed study found, nurses may be missing an opportunity to help reduce the maternal mortality rate in the U.S., the highest among affluent nations. An estimated 700 to 900 women die in the U.S. every year from pregnancy- and childbirth-related causes and 65,000 nearly die, according to the Centers for Disease Control. The rates are highest for black mothers and women in ruralareas. In a recent CDC Foundation analysis of data from four states, nearly 60 percent of maternal deaths were preventable.

Forty-six percent of nurses who responded to the survey were unaware that maternal mortality has risen in the U.S. in recent years, and 19 percent thought maternal deaths had actually declined. “If [nurses] aren’t aware that there’s been a rise in maternal mortality, then it makes it less urgent to explain to women what the warning signs are,” said study co-author Debra Bingham, who heads the Institute for Perinatal Quality Improvement and teaches at the University of Maryland School of Nursing.

Only 12 percent of the respondents knew that the majority of maternal deaths occur in the days and weeks after delivery. Only 24 percent correctly identified heart-related problems as the leading cause of maternal death in the U.S. In fact, cardiovascular disease and heart failure — which, according to recent data, account for more than a quarter of maternal deaths in this country — were “the area that the nurses felt the least confident in teaching about,” says Patricia Suplee, an associate professor at the Rutgers University School of Nursing in Camden, New Jersey, and the lead researcher on the study.

Nurses also said they spent very little time instructing new moms about worrisome symptoms — usually 10 minutes or less. Many of the nurses said they were only likely to discuss warning signs of such life-threatening conditions aspreeclampsia (pregnancy-related high blood pressure), blood clots in the lungs, or heart problems “if relevant” — even though, as the study noted, “it is impossible to accurately predict which women will suffer from a post-birth complication.”

The post-delivery education provided by nurses is particularly important because, once a mother leaves the hospital, she typically doesn’t see her own doctor for another four to six weeks. Up to 40 percent of new moms — overwhelmed with caring for an infant, and often lacking in maternity leave, child care, transportation and other kinds of support — never go back for their follow-up appointments at all.

The U.S. has the worst rate of maternal deaths in the developed world, and 60 percent are preventable. The death of Lauren Bloomstein, a neonatal nurse, in the hospital where she worked illustrates a profound disparity: the health care system focuses on babies but often ignores their mothers.

Figuring out the best way to instruct new mothers is all the more crucial, the survey noted, because the first days after giving birth are “exhausting, emotionally charged, and physiologically draining” — hardly an ideal learning environment. But like so many other important aspects of maternal health care, postpartum education has been poorly studied, Bingham said.

The respondents, of whom nearly one-third had master’s or doctorate degrees, were members of the Association of Women’s Health, Obstetric and Neonatal Nurses, the leading professional organization for nurses specializing in maternal and infant care. AWHONN began looking at the education issue in 2014, when Bingham was the association’s vice president of nursing research and education. “We had to start really from the ground up, because we didn’t know exactly what women were being taught,” she said.

In focus groups conducted in New Jersey and Georgia, two states with especially high rates of maternal mortality,researchers discovered that postpartum nurses spent most of their time educating moms about how to care for their new babies, not themselves. The information mothers did receive about their own health risks was wildly inconsistent, and sometimes incorrect, Bingham said. The written materials women took home often weren’t much better.

Some nurses were uncomfortable discussing the possibility that complications could be life-threatening. “We had some nurses come out and say, ‘Well you know what, I don’t want to scare the woman. This is supposed to be a happy time. I don’t want to seem like all I want to talk about is death,’” Bingham said.

But the researchers also found that nurses could be quickly educated with short, targeted information. Using insights from the focus groups, an expert panel developed two standardized tools — a checklist and script that nurses could follow when instructing new mothers and a one-page handout of post-birth warning signs that mothers could refer to after they returned home, with clear-cut instructions for when to see a doctor or call 911. Those tools were tested in four hospitals in 2015. “Very quickly we started hearing from the nurses that women were coming back to the hospital with the handout, saying, ‘I have this symptom,’” Bingham said.

One of them was a Georgia mom named Sarah Duckett, who had just given birth to her second child. A week later, she recognized the warning signs of what turned out to be a blood clot in her lung — an often fatal postpartum complication. “Those were anecdotes, but they were very powerful anecdotes,” Bingham said. “I’ve led multiple projects over the years and rarely do I get such immediate feedback that something is working.”

The shortcomings documented by the national survey could foster wider use of these tools, suggested Mary-Ann Etiebet, executive director of Merck for Mothers, which funded the study as part of a 10-year, $500 million initiative to improve maternal health around the world. “Something as simple as creating educational and training programs for nurses … can have a real impact,” she said.

Posted on 27 June 2018

HARTFORD — The Connecticut Department of Public Health on Wednesday announced the launch of Getting to Zero, a campaign to get to zero new HIV infections, zero AIDS-related deaths and zero HIV/AIDS-related stigma and discrimination. Wednesday is HIV testing day.

G2Z was launched in the five cities with the highest number of people living with HIV: Bridgeport, Hartford, New Haven, Waterbury and Stamford.

“While great strides have been made to curb HIV infections and improve health outcomes for people living with HIV, HIV continues to have a grossly disproportionate impact on young men having sex with men, particularly in communities of color, Black women and transgender individuals,” said DPH Commissioner Dr. Raul Pino at a State Capitol press conference launching the G2Z campaign. “Getting to Zero will focus more intently on these populations through the reframing of current thinking on HIV and retooling of strategies to curb HIV, with the goal being the elimination of new HIV infections, zero AIDS-related deaths and elimination of the stigma and discrimination suffered by people living with HIV/AIDS.”

According to DPH, in Connecticut in 2016, about 50 percent of HIV cases were among men having sex with men. The Centers for Disease Control and Prevention estimates that the lifetime risk of contracting HIV is one out of every two Black MSM and one out of every four Latino MSM.

In Connecticut, Black females are living with HIV at a rate approximately 12 times that of white females with one out of every 48 Black women at risk for contracting HIV over their lifetime. Black females were diagnosed with HIV at a rate 20 times that of white females between 2012 and 2016.

A 23-member commission appointed by Commissioner Pino, comprised of advocates from the at-risk populations in each city, AIDS service organization representatives, local health advocates, individuals living with HIV, and researchers from New Haven and Hartford, is currently collaborating with the health directors of the state’s five major cities to develop City Teams that will plan and implement community listening sessions over the summer in each of the cities with each affected population.

The goal of these sessions will be to learn from community members what barriers exist that prevent or inhibit the effective delivery of HIV services to the impacted populations. The sessions will also provide Commission members with an opportunity to educate participants on HIV in their city and best practices for preventing and treating HIV.

A final G2Z report will be presented to the DPH Commissioner in December, 2018.

“I’m proud that Connecticut is making a concerted effort to get to zero new HIV infections, zero HIV-related deaths, and to eliminate HIV-related stigma and discrimination,” said Hartford Mayor Luke Bronin. “Today people with HIV and AIDS can live long, healthy lives, and in Hartford, we work with hundreds of residents every year who are living with HIV/AIDS, connecting them to the care they need. We’re committed to getting to zero new infections by working with our community partners and with the Department of Public Health to expand access to prevention and treatment services.”

Posted on 01 May 2018

By Nina Martin, ProPublica

This story was co-published with NPR.

Doctors would see new mothers sooner and more frequently, and insurers would cover the increased visits, under sweeping new recommendations from the organization that sets standards of care for obstetrician-gynecologists in the U.S.

The 11-page “committee opinion” on “Optimizing Postpartum Care,” released today by the American College of Obstetricians and Gynecologists, represents a fundamental reimagining of how providers, insurers and patients can work together to improve care for women after giving birth. “To optimize the health of women and infants, postpartum care should become an ongoing process, rather than a single encounter, with services and support tailored to each woman’s individual needs,” the committee opinion states.

While an ACOG task force began rethinking its approach several years ago, the guidelines arrive at a moment of mounting concern about rising rates of pregnancy-related deaths and near-deaths in the U.S. As ProPublica and NPRhave reported, more than 700 women die every year in this country from causes related to pregnancy and childbirth andmore than 50,000 suffer life-threatening complications, among the worst records for maternal health in the industrialized world. The death rate for black mothers is three to four times that of white women.

The days and weeks after childbirth can be a time of particular vulnerability for new moms, with physical and emotional risks that include pain and infection, hypertension and stroke, heart problems, blood clots, anxiety and depression. More than half of maternal deaths occur after the baby is born, according to a new CDC Foundation report.

Yet for many women in the U.S., the ACOG committee opinion notes, the postpartum period is “devoid of formal or infor­mal maternal support.” This reflects a troubling tendency in the medical system — and throughout American society — to focus on the health and safety of the fetus or baby more than that of the mother. “The baby is the candy, the mom is the wrapper,” said Alison Stuebe, who teaches in the department of obstetrics and gynecology at the University of North Carolina School of Medicine and heads the task force that drafted the guidelines. “And once the candy is out of the wrapper, the wrapper is cast aside.”

The way that providers currently care for pregnant women and infants versus new mothers exemplifies this difference. During the prenatal period, a woman may see her OB-GYN a dozen or more times, including at least two checkups during her ninth month. Her baby’s first pediatric visit usually occurs a few days after birth. But the mother may not have a follow-up appointment with her own doctor until four to six weeks after delivery — and in many cases, insurance only covers one visit. “As soon as that baby comes out, [the mom] is kind of an afterthought,” said Tamika Auguste, associate medical director of the MedStar Health Simulation Training & Education Lab in Washington, D.C., and a co-author of the ACOG opinion.

For working mothers, having to wait four to six weeks makes it harder to arrange a check-up.

Some 23 percent of mothers employed outside the home are back on the job within 10 days of giving birth, a 2014 report for the U.S. Department of Labor found; another 22 percent return to work within 40 days. Lack of childcare and transportation can also present significant hurdles to accessing care. According to ACOG, as many as 40 percent of women skip their postpartum visit; for low-income women of color, the rates are even higher.

“You may have a woman that has asthma, is having problems lactating, and is obese, and when they come to see you at six weeks, we have missed the boat here,” Auguste said.

Nor is a single visit enough time to address a new mother’s questions and concerns, especially if she had a complicated pregnancy or is suffering from chronic conditions such as hypertension, diabetes or a mood disorder. “We’re trying to address all of the issues that women are dealing with after having a baby in one 20-minute encounter,” Stuebe said. “And that’s really hard to do.”

Under the new ACOG guidelines, women would see their providers much earlier — from within three days postpartum if they have suffered from severe hypertension to no later than three weeks if their pregnancies and deliveries were normal— and would return as often as needed. Depending on a woman’s symptoms and history, the final postpartum visit could take place as late as 12 weeks after delivery and ideally would include “a full assessment of physical, social, and psychological well-being,” from pain to weight loss to sexuality to management of chronic diseases, ACOG says.

See Our Series

Maternal Care and Preventable Deaths

In another significant change, ACOG is urging providers to emphasize in conversations with patients the long-term health risks associated with pregnancy complications such as preterm delivery, preeclampsia and gestational diabetes. “These risk factors are emerging as an important predictor of future [cardiovascular disease],” the recommendations state. “ … [B]ut because these conditions often resolve postpartum, the increased cardiovascular disease risk is not consistently communicated to women.”

The new guidelines urge doctors to take a proactive approach, helping patients develop a postpartum care plan while still pregnant, including a team of family and friends to provide social and other support. According to ACOG, one in four new mothers surveyed recently said they didn’t even have a phone number of a health care provider to contact with concerns about themselves or their babies.

ACOG isn’t the only organization calling for a reinvention of postpartum care; patient-safety groups, researchers, nursesand midwives have also tackled the issue, recasting the three months after birth as akin to a “fourth trimester.”

“The postpartum period has become a priority,” said Debra Bingham, a professor of nursing at the University of Maryland and executive director of the Institute for Perinatal Quality Improvement who has participated in many of these initiatives.

Some providers, including Brown, who is affiliated with Duke University, are already incorporating some of ACOG’s ideas. Still, putting the reforms into common practice may take years. One of the biggest impediments is insurance reimbursement. Currently, payment for prenatal care, delivery and a single post-birth visit is bundled together into one global fee, creating a disincentive for doctors to see patients more than once, Auguste said.

The disincentives are greater for women on Medicaid, which pays for about half of U.S. births. What’s more, in many states Medicaid coverage ends at two months postpartum. The ACOG opinion didn’t estimate the cost of implementing its recommendations.

Brown agreed that revamping how postpartum care is reimbursed is critical, and insurance representatives — along with members of other medical specialties — were on the ACOG task force that drafted the new guidelines. “I want to make sure that I get some employee health plans and some health systems to adopt this nationally,” Brown said.

Indeed, although the guidelines are aimed at OB-GYNs, they would require changes throughout the maternal care system. That’s what ACOG is hoping for. “It’s really a societal call to action,” Stuebe said.

Posted on 05 February 2018

WASHINGTON – The U.S. Centers for Disease Control and Prevention on Friday said the peak of the flu season, which has killed 52 people in Connecticut, is still to come.

“Our latest tracking data indicate that flu activity is still high and widespread across most of the nation and increasing overall,” said Dr. Anne Schuchat, the acting CDC director.

The CDC said there were an additional 16 flu deaths among children last week, bringing the nationwide total this season for youngsters to 53.

About half of those children apparently had been healthy and had no special vulnerability to this viral disease, Schuchat said. She also said 20 percent had received a flu vaccine.

There has been one pediatric flu death in Connecticut.

Schuchat said this is a banner year for hospitalizations caused by the flu.

“So far this year, the cumulative rate of hospitalizations is the highest since we’ve been tracking in this way, which goes back to 2010,” she said. “This is a very difficult season.”

Schuchat also said “it’s not too late to get (a flu) vaccine.”

Caused by viruses, flu is a contagious respiratory illness with mild to severe symptoms that can sometimes lead to death. The flu season begins in October and can last up to 20 weeks.

The very young and very old are most susceptible to dying from the flu.

The CDC said that overall, there were 17,024 new laboratory-confirmed cases of illness during the week ending Jan. 27, bringing the season total to 126,117. But those numbers do not include all the people who have had the flu, as many do not see a doctor when sick.

The Connecticut Department of Public Health on Thursday said a total of 1,154 patients have been hospitalized with confirmed cases of flu this season.

The CDC said there are several strains of flu making people sick this winter. But the agency said most people with influenza are being infected with the H3N2 virus.

“In seasons where H3N2 is the main cause of influenza, we see more cases, more visits to the doctor, more hospitalizations, and more deaths,” said Dan Jernigan the director of the Influenza Division at the CDC.

As the nation is gripped with a particularly severe and dangerous flu season, there is a shakeup at the CDC.

Brenda Fitzgerald resigned as head of the CDC Wednesday, a day after Politico reported Fitzgerald’s purchase of tobacco stock after she took the position at the nation’s top public health agency.

Posted on 24 January 2018

HARTFORD — In effort to protect the public’s health and reduce the spread of the flu virus, the Connecticut Department of Public Health is teaming up with local health departments to provide free or low cost flu vaccine.

The department is strongly encouraging all Connecticut residents over the age of 6 months to get a flu shot. Free flu vaccine will be available at several locations across the state on Jan. 27.

It is not too late to get protection from the flu this season, state officials said.

The schedule and locations of Flu Clinics on Jan. 27 can be found on the DPH website:

Vaccine administered to children 18 years of age and younger will be made available free of charge. Vaccine for children comes from the Connecticut Vaccine Program. Managed by DPH, this program provides influenza vaccine free of charge for all children 6 months through 18 years of age. Adult vaccine will be provided at no cost to those without insurance.

Residents with insurance should bring their card and will be charged a small administrative fee, but will not be charged out of pocket for the vaccine. State health officials say flu activity in Connecticut continues to increase. As of Jan. 13, more 1,342 people have tested positive for the flu so far this season, and 615 have been hospitalized with the illness. There have also been 21 flu-related deaths so far this season.